Clinical Usefulness of Cancer Antigen (CA) 125, Human Epididymis 4, and CA72-4 Levels and Risk of Ovarian Malignancy Algorithm Values for Diagnosing Ovarian Tumors in Korean Patients With and Without Endometriosis

ObjectivesSince the recognition of borderline ovarian tumors (BOTs) in the 1970s, the management of this subset of epithelial ovarian tumors has presented a challenge to clinicians. The majority present at an early stage, but their diagnosis is often only made following surgery, hence the heterogeneity of surgical management. Borderline ovarian tumors are morphologically diverse, and their behavior is subsequently also heterogeneous. We aimed to assess recurrence rates and the rate of malignant transformation in patients diagnosed with BOT. Secondary objectives included a review of current management and assessment of tumor markers, stage, cyst dimensions, and the presence of micropapillary features as prognostic indicators of recurrence.MethodsThis retrospective cohort study included all patients treated with BOT between 2000 and 2015 in the southeast region of Scotland. Clinical, surgicopathological, and follow-up data were collated. Data were analyzed with reference to recurrence and malignant transformation.ResultsTwo hundred seventy-five patients underwent treatment for BOT in the study period. Surgical management was highly variable. A diagnosis of recurrent/persistent BOT or ovarian malignancy following initial treatment of BOT was rare, with only 12 (4%) of 275 cases. There were 7 cases (3%) of ovarian malignancy. Advanced International Federation of Gynecology and Obstetrics stage was the most prominent prognostic factor. Elevated preoperative serum CA-125 and the presence of micropapillary features correlated with advanced stage at presentation. With a lack of clear guidance, follow-up was highly variable with a median of 43 months (0–136 months).ConclusionsTo our knowledge, this study is the largest BOT cohort in the United Kingdom. Recurrent disease is rare in optimally staged, completely resected, early-stage BOT, without high-risk features. Caution is needed in women electing not to undergo completion staging after diagnosis and in those opting for a fertility-preserving approach. Thorough informed consent and clear plans for surveillance and follow-up are needed with consideration of delayed completion surgery as appropriate.

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Adnexal mass with extremely high levels of CA-125 and CA19-9 but normal Human Epididymis Protein 4 (HE4) and Risk of Ovarian Malignancy Algorithm (ROMA): Endometriosis or ovarian malignancy? A case report

International Journal of Reproductive BioMedicine ◽

10.29252/ijrm.16.6.413 ◽

2018 ◽

Vol 16 (6) ◽

pp. 413-416

Author(s):

Sepideh Khodaverdi ◽

Soheila Amini-Moghaddam ◽

◽

Keyword(s):

Case Report ◽

Adnexal Mass ◽

Ca 125 ◽

Ovarian Malignancy ◽

Human Epididymis Protein 4 ◽

Human Epididymis ◽

Normal Human

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Risk of malignancy index in ovarian tumour for predicting ovarian malignancy by using Jacob’s score

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171385 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1318

Author(s):

Rao P. S. ◽

Bala Reenu ◽

S. Prajwal

Keyword(s):

Predictive Value ◽

Case Fatality ◽

Ovarian Tumors ◽

Ca 125 ◽

Ovarian Malignancy ◽

Gynecological Malignancy ◽

Menopausal Women ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Post Menopausal

Background: Ovarian malignancy is the most common gynecological malignancy after the cancer of the cervix. A woman's risk at birth of ovarian cancer at some time in her life is 1 % to 1.5% and that of dying from cancer is almost 0.5 %. The most commonly occurring ovarian tumors are of epithelial in origin. It has the highest case-fatality ratio of all gynecological malignancies. Hence the early diagnosis is the most important factor for better prognosis. A clinical evaluation of the patient, followed by ultrasonography and CA-125 is helpful. This study aims to determine the role of Risk of Malignancy Index (Jacob’s RMI) in ovarian tumors for prediction of ovarian malignancy.Methods: This is a prospective cohort study. The present study was carried out at department of OBG, in collaboration with the Departments of Radio diagnosis and Pathology, AHRR, New Delhi. 100 patients meeting the inclusion and exclusion criteria were considered. Detailed clinical history, examination and ultrasonography (Abdomen and pelvis) were done. Estimation of CA125 was done thereafter. Calculated JACOBS RMI score was compared with operative surgical staging and histopathological-cytological examination of the specimen. Data obtained thereafter was analysed using appropriate and relevant statistical software.Results: In present study sensitivity of RMI Score in the pre-menopausal women was 66.7% and in post-menopausal women was 83.3%. Specificity of RMI Score in the pre-menopausal women was 96.3% and in post-menopausal women was 81.8%. The positive predictive value in the pre-menopausal women was 40% and in post-menopausal women was 71.4%. The negative predictive value in the pre-menopausal women was 98.7% and in post-menopausal women was 90%. Diagnostic accuracy in a case of premenopausal women was is 95.2% and 82.4% for postmenopausal women.Conclusions: The present study shows that RMI Score helps in identifying effectively those patients who require Staging Laparotomy and hence referral to Gynecologist Oncologist. Patients with ovarian masses with low risk of malignancy index can be treated by minimal access procedures.

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Evaluation in the predictive value of serum human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both in detecting ovarian malignancy

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2018-0029 ◽

2018 ◽

Vol 35 (1) ◽

Author(s):

Beng Hock Teh ◽

Soon Leong Yong ◽

Wee Wee Sim ◽

Kim Bee Lau ◽

Haris Njoo Suharjono

Keyword(s):

Predictive Value ◽

Area Under The Curve ◽

Pelvic Mass ◽

Premenopausal Women ◽

Ca 125 ◽

Diagnostic Study ◽

Ovarian Malignancy ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Sensitivity Specificity

Abstract Background This study was conducted to evaluate the performance of human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both via the Risk of Ovarian Malignancy Algorithm (ROMA) in detecting ovarian malignancy. Methods This was a diagnostic study enrolling 129 patients with pelvic mass(es) suspected of originating in the ovary who had been scheduled for surgery or radiological-guided biopsy. Serum HE4 and CA 125 levels were measured. HE4, CA 125 and ROMA were evaluated for sensitivity, specificity, positive predictive value and negative predictive value. The receiver operating characteristic (ROC) plots were graphed and area under the curve (AUC) values were calculated to investigate the accuracy of each marker for predicting ovarian malignancy. Results Overall, CA 125 remained significantly more sensitive (88.9% vs. 51.9%, p = 0.006) but less specific (56.9% vs. 95.1%, p < 0.001) than HE4. HE4 was superior to CA 125 in specificity (97.7% vs. 54.5%, p < 0.001) for premenopausal women. ROMA was non-significantly more sensitive (100.0% vs. 92.3%, p = 1.000) than CA 125 but both were equally specific (71.4%) for the postmenopausal group. In the premenopausal group, the AUC of serum HE4 was higher than serum CA 125 (0.851 vs. 0.817) but was equivalent to ROMA (0.851 vs. 0.859). In the postmenopausal group, ROMA exhibited an excellent AUC value as compared to CA 125 and HE4 (AUC of 0.907 vs. 0.874 vs. 0.863, respectively). Conclusion HE4 is useful in ruling out ovarian malignancy among premenopausal women. For postmenopausal women, ROMA appears to be an all-rounder with overall good sensitivity and specificity.

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Comparison of Serum Human Epididymis Protein 4 with Cancer Antigen 125 as a Tumor Marker in Patients with Malignant and Nonmalignant Diseases

Clinical Chemistry ◽

10.1373/clinchem.2010.157073 ◽

2011 ◽

Vol 57 (11) ◽

pp. 1534-1544 ◽

Cited By ~ 114

Author(s):

Jose M Escudero ◽

Jose M Auge ◽

Xavier Filella ◽

Aureli Torne ◽

Jaume Pahisa ◽

...

Keyword(s):

Ovarian Cancer ◽

Tumor Marker ◽

Ca 125 ◽

Malignant Diseases ◽

Healthy Individuals ◽

Cancer Antigen 125 ◽

Benign Diseases ◽

Cancer Antigen ◽

Human Epididymis Protein 4 ◽

Human Epididymis

BACKGROUND Human epididymis protein 4 (HE4), a precursor of human epididymis protein, has been proposed as a tumor marker for ovarian cancer. We evaluated HE4 in comparison with cancer antigen 125 (CA 125) in healthy individuals and in patients with benign and malignant diseases. METHODS CA 125 and HE4 serum concentrations were determined in 101 healthy individuals, 535 patients with benign pathologies (292 with benign gynecologic diseases) and 423 patients with malignant diseases (127 with ovarian cancers). CA 125 and HE4 cutoffs were 35 kU/L and 140 pmol/L, respectively. RESULTS HE4 and CA 125 results were abnormal in 1.1% and 9.9% of healthy individuals and in 12.3% and 37% of patients with benign diseases, respectively. Renal failure was the most common cause of increased HE4 in patients with benign disease, who had significantly higher HE4 concentrations (P = 0.001) than patients with other benign diseases. HE4 showed a higher specificity than CA 125 in patients with benign gynecologic diseases, with abnormal concentrations in 1.3% and 33.2% of the patients, respectively. HE-4 concentrations were abnormal primarily in gynecologic cancer and lung cancer. By contrast, CA 125 was increased in many different nonovarian malignancies, including nonepithelial tumors. A significantly higher area under the ROC curve was obtained with HE4 than with CA 125 for differentiating benign from malignant diseases (0.755 vs 0.643) and in the differential diagnosis of gynecologic diseases (0.874 vs 0.722). CONCLUSIONS HE4 has significantly higher diagnostic specificity than CA 125, and the combination of CA 125 and HE4 improved the detection of ovarian cancer in all stages and histological types.

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Intra-abdominal tuberculosis masquerading as ovarian carcinoma

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz361 ◽

2019 ◽

Vol 2019 (12) ◽

Cited By ~ 2

Author(s):

Yaying Eileen Xu ◽

Kimberley Tan ◽

Rasika Hendahewa

Keyword(s):

Granulomatous Inflammation ◽

Abdominal Tuberculosis ◽

The Philippines ◽

Ca 125 ◽

Ovarian Malignancy ◽

Cancer Antigen ◽

Delay In Diagnosis ◽

Menopausal Women ◽

Standard Mode ◽

Symptoms And Signs

Abstract Intra-abdominal tuberculosis (TB) is rare in Australia, but it can be found in those who emigrate from endemic areas. We report a rare case of a 28-year-old lady from the Philippines who presented with abdominal pain, ascites and an elevated cancer antigen (CA) 125 with an initial concern of ovarian malignancy. She underwent a diagnostic laparoscopy which revealed typical features of intra-abdominal TB and histological features of granulomatous inflammation. The symptoms and signs of intra-abdominal TB are non-specific and can mimic many other conditions. The gold-standard mode of diagnosis in intra-abdominal TB is laparoscopy with tissue biopsy. Ovarian malignancy is relatively rare in pre-menopausal women; hence an elevated CA 125 warrants a broader differential diagnosis. It is important to have intra-abdominal TB as a differential even in the non-endemic settings to avoid delay in diagnosis and appropriate management.

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